Category Archives: Working Papers

The need for Economies of Alignment in the US Healthcare system

Title: The need for Economies of Alignment in the US Healthcare system
Author; Philip Boxer
Category: Working Paper

The trigger for this note is an article in the NY Times referring to the work of Peter Orszag on HealthCare Policy, the background to which are the significant shortcomings in overuse, underuse and misuse of healthcare services. The core challenge is to engineer healthcare systems that can focus explicitly on indirect as well as direct benefits for patients. It is challenging to support and sustain the collaborations needed to do this with respect to the varieties of through-life conditions presented by patients, because it calls for a different approach to defining value within the larger healthcare ecosystem.

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The Double Challenge: working through the tension between meaning and motivation in a large system

Title: The Double Challenge: working through the tension between meaning and motivation in a large system
Author: Philip Boxer
Category: Working Paper

An enterprise is made up of a number of systems of practice within which its work is organized, whether the enterprise is public or private, virtual or not, or for profit or not. Such an enterprise faces a double challenge in the way it elaborates its systems of practice: this challenge places it between what it knows how to do, and the demands made on it by turbulent environments that take it beyond what it knows. A case study of a large system, the US wildland fire service, is used to exemplify these ideas, and the implications for considering the kinds of leadership that are needed to meet this challenge. Motivation is defined as that which emerges where there are gaps in the ability of the enterprise to do what it needs to survive and prosper, that is gaps in its systems of practice. These gaps are understood as ‘driving’ the enterprise, and show themselves as dilemmas that are symptomatic of these gaps. The double challenge presented by these dilemmas are relate to vertical and horizontal kinds of leadership. Horizontal leadership is then linked to the need for a consulting ethic that is reflexive.

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Triply Articulated Modelling of the Anticipatory Enterprise

Title: Triply Articulated Modelling of the Anticipatory Enterprise
Author: Boxer, P.J. & Cohen, B.
Category: Working
Publication Year: 2004
Where Published: International Conference on Complex Systems, Boston.

Abstract:

People expect the behaviours of large, complex systems of systems to be embedded in their personal contexts-of-use. But suppliers of such systems often persuade their users to settle for something less than their particular needs because that something is better than nothing. Digitisation is turning this whole approach to designing complex systems of systems inside out. New approaches are required to understanding the nature of these complex systems which address risk, meaning and composition in ways that place the user of such systems at the centre of their formation instead of at their periphery. This paper outlines such an approach and the demands it places on the processes of collaborative composition.

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Reflexive Team Supervision: questioning ‘by whose authority’

Title: Reflexive Team Supervision: questioning ‘by whose authority’
Author: Boxer, P.J. & Eigen, C.A.
Category: Working
Publication Year: 2003
Where Published: OPUS Conference, London
Abstract:

Consultants working in large complex systems, for example the NHS, face a daunting task. They must address the problem as presented, but in the process of so doing, they must also address the context in relation to which the problem is inevitably symptomatic. Reflexive team supervision is a method in which a shadow consultancy team enables the consultant to engage with these issues by utilising the way s/he functions in relation to the consultant-client system. The shadow team challenges itself to question its own thinking and to experience its own tendency to avoid anxiety through ignoring the painful issues and intractable resistance to movement exhibited by the consultant as s/he intervenes in the client system. It offers a composite voice through its circular questioning, paradoxical intervention and systemic hypotheses. As a result, the impossibility of the situation is accentuated and the dilemmas of the case are made visible as it exposes the lacunae in its own ways of thinking and knowing that which is to be taken as being true. The shadow team, in making its difficulties of large system thinking and hypothesis building transparent in this way, thereby makes its learning available for use by the consultant. The methodology of reflexive team supervision combines key elements of working conference dynamics and the practices of systemic shadow consultancy to explore the ways in which problems experienced in the client system are being authorized. The paper presents a case example of work with a single consultant over a 9 month period of time. The supervision design, consulting processes and client outcomes associated with the case are discussed and conclusions drawn.

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